Implementing a Trauma-Informed Public Health System in San Francisco, California

Abstract

Background. Trauma is a ubiquitous and harmful public health concern. Much like individuals, organizations experience trauma and can embed it within their culture. Left unaddressed, trauma inhibits staff from confronting problems, communicating effectively, and generating solutions, factors that undermine organizational functioning. In response to trauma’s far-reaching impact, recent efforts have focused on creating “trauma-informed” systems that emphasize safety and avoid retraumatization. Trauma-informed systems are uniquely connected to relationships, as the impact of trauma both impairs relationships and is heightened in the absence of quality relationships. Developing trauma-informed relationships is therefore critical to creating a healing organizational culture. Aims. The objective of this article is to describe the process through which the San Francisco Department of Public Health (SFDPH) developed and implemented their Trauma-Informed Systems (TIS) Initiative, an organizational model to address trauma at the systems level. The article highlights the centrality of trauma-informed relationships to the initiative’s guiding principles, activities, and implementation process. Discussion. Six core principles underlie the work of the SFDPH’s TIS Initiative: (1) Understanding Trauma & Stress, (2) Compassion & Dependability, (3) Safety & Stability, (4) Collaboration & Empowerment, (5) Cultural Humility & Responsiveness, (6) Resilience & Recovery. Initiative components focus on creating and sustaining trauma-informed knowledge (i.e., foundational training, train-the-trainer program) and organizational practices (i.e., aligned efforts, leadership, and champion engagement). Conclusion. Trauma-informed systems represent an emergent organization-level intervention designed to address trauma and its sequelae. SFDPH’s TIS Initiative is creating a healing organization through its innovative response to the impact of trauma.

Nationwide efforts for trauma-informed care implementation and workforce development in healthcare and related fields: a systematic review

“…65,66 Organizations and communities that have most successfully implemented TIC have reviewed and amended TIC procedures and policies, provided training to all staff and aligning staff hires with TIC training, followed recommended guidelines, and adopted refinements in TIC, such as service user involvement and ongoing staff training using system-level approaches. [67][68][69][70][71][72] Healthcare systems remain an important setting for identifying children and families who have been exposed to trauma. Pediatricians and other childcare providers are integral to the process of implementing TIC, especially if they work in a trauma-informed system and are properly trained.…”

“…53,61,65 In some institutions, organizational leadership has implemented institution-wide training and education for their staff and administrators to ensure TIC principles are practiced across the organization. 66,67,69,[72][73][74][78][79][80] Various curricula have been developed and piloted for healthcare professionals in different settings, which were designed to ultimately result in more effective patient-centered communication and intervention around ACEs. [81][82][83][84] Existing programs have also discussed self-awareness and self-care in order to mitigate the impact of trauma that healthcare providers may have experienced themselves.…”

“…79,100,103,105 States committed to multisystem TIC approaches demonstrate the importance of working across multiple systems when developing interventions for children and families who are often involved in more than one system. 57,67,72 This 'trauma-informed systems' approach promotes shared beliefs, values, and practice approaches among organizations, some of which are multilevel interventions that provide workforce training along with policy changes, while others offer targeted services, such as child welfare screenings across multiple agencies. 72,105,110,111 In fact, with the recognition that cross-system TIC implementation may improve health, social, and educational outcomes simultaneously, numerous states have started efforts to build capacity to deliver TIC across systems serving children and their families, including child welfare, education, health and mental health systems.…”

Applying Trauma-Informed Practices to the Care of Refugee and Immigrant Youth: 10 Clinical Pearls

“…Trauma is defined as “an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life-threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being” [13]. In the context of pediatric care, TIC is an approach that recognizes the pervasive impact of trauma on children’s development and health (as well more broadly throughout systems of service delivery), applies this knowledge of trauma and its consequence into practice, and actively seeks to prevent re-traumatization [13,14,15,16]. It is often considered a lens through which to view and interpret child health and outcomes, rather than a specific set of directives.…”

Staff Exposure to Trauma and the Impact of Trauma-Informed Care

“…However, these findings were limited by a low response rate (15% organizations contacted), missing data in significant number of returned surveys, and, the lack of sufficient respondents in each organization (an average of 3 per organization) to make meaningful comparisons. Despite the proliferation of discussion about TIC principles, and efforts to describe and provide training on implementation, [35], there is consensus among researchers that there is a paucity of research on the impact on staff or organizations as a result of implementing TIC [6,17,25,26].…”